Abordaje endoscópico extendido del seno frontal: Experiencia en Hospital Clínico Universidad de Chile / Extended endoscopic approach of the frontal sinus: Experience at Hospital Clínico Universidad de Chile

Introducción: El seno frontal es una estructura compleja y desafiante en términos quirúrgicos, siendo descritas numerosas técnicas para su abordaje. Dentro de ellas se destaca el abordaje endoscópico extendido de seno frontal: Draf IIB y Draf III, como una importante alternativa para resolución de patología refractaria de seno frontal. Objetivo: Describir las características de pacientes sometidos a abordaje endoscópico extendido de seno frontal en Hospital Clínico Universidad de Chile (HCUCH). Material y Método: Estudio retrospectivo, descriptivo. Se incluyeron a pacientes sometidos a abordaje endoscópico extendido de seno frontal entre los años 2013 y 2021. Se analizaron variables clínicas, intraoperatorias y de seguimiento. Resultados: Se registraron 118 pacientes, de los cuales 64 cumplieron criterios de inclusión al estudio, con una edad promedio de 48 años. La patología más frecuente fue la rinosinusitis crónica poliposa (42%) seguido del mucocele (20%). Del total de pacientes, el 68% fue sometido a cirugía Draf IIB y el resto a Draf III. Todos los pacientes fueron estudiados con endoscopía e imágenes, y seguidos con parámetros clínicos y endoscópicos. El porcentaje de estenosis postoperatoria se estimó en 10%. Conclusión: El abordaje endoscópico nasal extendido figura como una alternativa útil para manejo de patología de seno frontal refractario a tratamiento. En nuestra experiencia las indicaciones, tipos de cirugía y tasa de complicaciones son concordantes con la literatura internacional.

Introduction: The frontal sinus is a complex and challenging structure in surgical terms, numerous techniques have been described for its approach, among them the extended endoscopic approach: Draf IIB and Draf III, figures as an important alternative for the resolution of refractory pathology of frontal sinus. Aim: To describe the characteristics of patients who underwent an extended endoscopic approach to the frontal sinus at the Hospital Clínico Universidad de Chile (HCUCH). Material and Method: A retrospective, descriptive study included patients who underwent an extended endoscopic approach to the frontal sinus between 2013 and 2021. Clinical, intraoperative, and follow-up variables were analyzed. Results: 118 patients were registered, of which 64 met the inclusion criteria for the study, with an average age of 48 years. The most frequent pathology was chronic polypous rhinosinusitis (42%), followed by mucocele (20%). Of the patients, 68% underwent Draf IIB surgery, while the rest received a Draf III type procedure. All patients were studied with endoscopy and images and followed up with clinical and endoscopic parameters. The percentage of post operatory stenosis was 10%. Conclusion: The extended nasal endoscopic approach appears as a valuable alternative for managing frontal sinus pathology refractory to treatment. In our experience, the indications, types of surgery, and rate of complications are consistent with the international literature.

Características clínicas y hallazgos endoscópicos en niños con hipertensión portal atendidos en un hospital pediátrico / Clinical characteristics and endoscopic findings in children with portal hypertension seen in a pediatric hospital

Antecedentes: El término hipertensión portal (HP) se define como el aumento patológico en el gradiente de presión porto-sistémico en cualquier segmento del sistema venoso portal. Objetivo: Determinar las características clínicas y hallazgos endoscópicos de pacientes con HP atendidos en el Hospital María, Especialidades Pediátricas (HMEP). Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo. El universo fueron todos los pacientes de 18 años o menos con diagnóstico de HP que asistieron al servicio de gastroenterología pediátrica del HMEP entre 2015-2022. Fue tomado todo el universo para aná- lisis. Se realizó análisis de datos descriptivo univariado utilizando el programa STATA 15.1. Resultados: Se analizó un total de 38 pacientes, 55.3% (21/38) de edad preescolar. El 57.9% (22/38) fue masculino y el nivel de escolaridad más frecuente fue primaria incompleta en 55.3%. La procedencia en 79% (30/38) de la zona centro y oriente del país. El Sangrado Digestivo Alto (SDA) se en- contró en 42% de los pacientes (16/38) y la etiología pre-hepática fue la más frecuente en 65.8 % (25). Discusión: se encontró que el inicio de la enfermedad fue en pre-escolares con predominio del sexo masculino; las causas pre-hepáticas fueron la etiología más frecuente de SDA coincidiendo con lo publicado por otros autores. El SDA fue el síntoma inicial predominante, evidenciado en hallazgos endoscópicos como várices esofágicas y gástricas. Conclusión: La HP es poco frecuente en edad pediátrica tiene consecuencias severas en la calidad de vida y sobrevida del paciente...(AU)

Hemostasia en cirugía funcional endoscópica (CEF): Revisión de las recomendaciones de la literatura internacional / Hemostasis in functional endoscopic sinus surgeries (FESS): Review of the international literature recommendations

El manejo del sangrado en CEF es fundamental, ya que aumenta la tasa de complicaciones. El principal objetivo del manejo perioperatorio es lograr una buena hemostasia, es por esto que se realizó una revisión de las principales recomendaciones de la literatura internacional, que incluye medidas preoperatorias, intraoperatorias y postoperatorias.

Bleeding is an important factor in FESS since it increases the rate of complications. The main objective of perioperative management is to achieve good hemostasis. This is a review of the main recommendations of the international literature, that includes preoperative, intraoperative and postoperative measures.

Divertículo de Zenker / Zenker's Diverticulum

Introducción: Los divertículos de Zenker son los más frecuentes del esófago. El tratamiento quirúrgico más utilizado es la diverticulectomía con miotomía cricofaríngea abierta. Objetivo: Describir un paciente con diagnóstico de divertículo de Zenker cuya presentación fue la disfagia e infecciones respiratorias recurrentes. Presentación del caso: Describimos el caso de una paciente de 73 años con disfagia alta e infecciones respiratorias recurrentes, con el diagnóstico de divertículo de Zenker, a quien se le realiza diverticulectomía más miotomía. Conclusiones: El divertículo de Zenker o divertículo yuxtaesfinteriano faringoesofágico es una entidad de baja prevalencia que se presenta en pacientes entre los 50 y 70 años, predominantemente en los de sexo masculino. La radiografía contrastada del tracto digestivo superior y endoscopia determinan el diagnóstico en su mayoría y la diverticulectomía más cricomiotomía es la técnica más empleada(AU)

Introduction: Zenker's diverticula are the most frequent diverticula of the esophagus. The most commonly used surgical treatment is diverticulectomy with open cricopharyngeal myotomy. Objective: To describe a patient with a diagnosis of Zenker's diverticulum and whose presentation was dysphagia and recurrent respiratory infections. Case presentation: We describe the case of a 73-year-old female patient with high dysphagia and recurrent respiratory infections, with the diagnosis of Zenker's diverticulum, and who underwent diverticulectomy plus myotomy. Conclusions: Zenker's diverticulum or pharyngoesophageal juxtasphincteric diverticulum is a low-prevalence condition that occurs in patients between 50 and 70 years of age, predominantly in males. Contrast radiography of the upper digestive tract and endoscopy determine the diagnosis in the majority of cases, while diverticulectomy plus cricomyotomy is the most commonly used technique(AU)

Seguridad de los portales para la reparación endoscópica del ligamento calcaneonavicular: estudio cadavérico / Endoscopic Spring ligament repair. Anatomic evaluation of portal safety

Introducción: La lesión del ligamento calcaneonavicular ha sido descrita como una de las causas de la deformidad en el pie plano del adulto. El objetivo de este artículo es describir portales modificados para el diagnóstico y la reparación endoscópica de las lesiones del fascículo superomedial del ligamento calcaneonavicular y evaluar la seguridad de los portales utilizados. Materiales y Métodos:Se llevó a cabo un estudio cadavérico con seis preparados reproduciendo una lesión del fascículo superomedial del ligamento calcaneonavicular con una punta de corte de radiofrecuencia y la posterior reparación endoscópica. Se crearon dos portales modificados para el abordaje. Luego se procedió a la disección anatómica para evaluar la seguridad de los portales en relación con las estructuras anatómicas. El primer portal se realiza inmediatamente proximal a una línea trazada desde la punta del maléolo medial dirigida al centro del talón, el segundo portal se emplaza 0,5 cm proximal a la inserción del tendón tibial posterior en el escafoides por transiluminación. Si es necesario, se coloca un portal accesorio inmediatamente dorsal al tendón tibial posterior a mitad de camino entre los dos portales antes descritos. Resultados:En todos los casos, fue posible la reparación del ligamento con el procedimiento endoscópico. En la disección anatómica de los portales, se observó una distancia promedio a las estructuras vasculonerviosas de 11,83 mm del portal proximal y de 9,66 mm del portal distal. Conclusión: Los portales modificados son seguros y permiten la visualización directa del haz superomedial del ligamento calcaneonavicular y su reparación endoscópica. Nivel de Evidencia: IV

Introduction: Calcaneonavicular ligament injury has been described as a cause of adult flat foot deformity. The objective of this study is to describe modified portals for the diagnosis and treatment of injuries to the superomedial bundle of the calcaneonavicular ligament and to evaluate the safety of the portals used. Materials and Methods: We performed a cadaveric specimen study on 6 feet, where we reproduced a lesion of the superomedial bundle of the calcaneonavicular ligament with a radiofrequency ablation device and repaired it endoscopically. Two modified portals were created for the approach and an anatomical dissection was performed to assess the safety of the portals in relation to the anatomical structures. The first portal was placed immediately proximal to a line drawn from the tip of the medial malleolus toward the center of the heel; the second portal was placed 0.5 cm proximal to the posterior tibial tendon insertion into the navicular bone, guided by transillumination. If needed, an accessory portal was placed halfway between the two previously described portals immediately dorsal to the posterior tibial tendon. Results:In all cases, ligament repair was achieved with the endoscopic procedure. In the anatomical dissection of the portals, we observed an average distance of 11.83 mm from the proximal portal and 9.66 mm from the distal portal to neurovascular structures. Conclusion:Modified portals are safe and allow direct visualization of the superomedial bundle of the calcaneonavicular ligament to perform endoscopic repair. Level of Evidence: IV

The correlation between FCER2 gene polymorphism and the efficacy of inhaled corticosteroids in patients with chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the correlation between FCER2（2206A>G） gene polymorphism and the efficacy of inhaled corticosteroids（ICS） in patients with chronic rhinosinusitis（CRS）. Methods:A total of 208 CRS patients were routinely treated with functional endonasal sinus surgery and postoperative ICS. DNA extraction, PCR amplification and gene sequencing were performed to observe the FCER2（2206A>G） gene polymorphism and calculate the allele frequency. The visual analog scale（VAS） score, Lund-Kennedy score, and computed tomography（CT） Lund-Mackay score were determined 6 months after surgery among patients with different genotypes. Moreover, the polymorphism frequency was compared among different subgroups（chronic rhinosinusitis with nasal polyps versus chronic rhinosinusitis without nasal polyps, eosinophilic chronic rhinosinusitis versus non-eosinophilic chronic rhinosinusitis）. Results:There were FCER2（2206A>G） gene polymorphism in patients with CRS, and the phenotypes included 3 genotypes, AA, AG and GG, with distribution frequencies of 68（32.7%）, 116（55.8%） and 24（11.5%） cases, respectively. No significant differences were found in age, VAS score, nasal endoscopic Lund-Kennedy score and CT imaging Lund-Mackay score among patients with CRS of each genotype before surgery. In patients with the AA genotype, the changes in VAS score（5.74±1.10）, Lund Kennedy score（5.92 ± 1.14）, and CT imaging Lund-Mackay score（13.26±4.26） were significantly higher than in patients with the AG（4.37±0.86, 5.37±1.24, 10.82±3.77） and GG（4.26±0.80, 5.18±1.56, 10.10±3.53） genotype（P<0.05）. However, there were no marked difference between patients with the AG genotype and those with the GG genotype（P>0.05）. Compared with patients with non-eosinophilic sinusitis, Among them, the differences between the GG genotype and AG /AA genes were more significant in eosinophilic sinusitis compared to non-eosinophilic sinusitis（P<0.01）. Conclusion:The FCER2（2206A>G） gene in patients with CRS has genetic polymorphism and is associated with the recovery of CRS patients after surgery, individual corticosteroid sensitivity, and subgroup variability.

Efficacy evaluation of transaxillary non-inflatable endoscopic surgery and open neck surgery in the treatment of PTC: a single center report of 342 cases / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical effect of transaxillary non-inflatable endoscopic surgery and traditional open thyroid surgery in the treatment of PTC. Methods:A retrospective analysis was performed on 342 patients with PTC treated in the Otorhinolaryngology Department of Qilu Hospital of Shandong University from December 2020 to December 2022. There were 73 males and 269 females, aged 16-72 years, who underwent unilateral non-inflatable transaxillary endoscopic thyroid surgery（endoscopic group） and unilateral traditional open thyroid surgery（open group）. There were 108 patients in the endoscopic group and 234 in the open group. Results:The endoscopic group was lower in age（37.1±9.4 vs 43.5±11.2） years and BMI（23.4±3.4 vs 25.7±3.8 ）kg/m² than that in the open group, and the difference was statistically significant（t was 5.53, 5.67 respectively, P<0.01）. There was no significant difference in hospitalization days between the two groups（P>0.05）. The logarithmic curve of the operation time showed a smooth downward trend, and the overall operation time of the endoscopic group was relatively consistent. There was no significant difference in intraoperative blood loss between the endoscopic group（13.3±3.2） mL and the open group（14.7±6.3） mL（P>0.05）, but the operation time（130.1±37.9） min was longer than that in the open group（57.4±13.7） min, and the difference was statistically significant（t=19.40, P<0.01）. There was no significant difference in complications such as temporary recurrent laryngeal nerve injury within 3 days after operation between the two groups（P>0.05）. The aesthetic satisfaction score of the surgical incision and the incision concealment effect score in the endoscopic group were higher than those in the open group, and the difference was statistically significant（P<0.05）. Conclusion:Compared with traditional open thyroidectomy, transaxillary non-inflatable endoscopic thyroidectomy has more advantages in the concealment and aesthetics of postoperative incision. Although the former has longer operation time and more drainage, it is still a safe and feasible surgical method with good postoperative clinical effect.

Application of virtual endoscopy in the diagnosis of adenoid hypertrophy and the morphologic classification of adenoid / 临床耳鼻咽喉头颈外科杂志

Objective:To discuss the application of virtual endoscopy in the diagnosis of adenoid hypertrophy and the morphologic classification of adenoid. Methods:The clinical data of 97 children with adenoid hypertrophy admitted to Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital from July 2022 to December 2022 were collected. The virtual endoscopic reconstruction of the nasopharynx was performed by cone beam computed tomography. The results of virtual endoscopic adenoid size measurement were compared with the results of nasopharyngeal CT median sagittal position and nasopharyngeal endoscopy. Virtual endoscopic classification of adenoid based on the size of the adenoids and their relationship with the torus tubarius. Results:The t-test results of the size of adenoids measured by virtual endoscopy and nasopharyngeal CT were t=1.699 and P=0.093, and the results of intra-group correlation coefficient（ICC） analysis were ICC=0.921 and P<0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal CT was highly consistent. The t-test results of the size of adenoids measured virtual endoscopy and nasopharyngeal endoscopy were t=1.543 and P=0.15, and the results of intra-group correlation coefficient（ICC） analysis were ICC=0.900 and P<0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal endoscopy was highly consistent. Among the 97 children, the morphological classification results of adenoids were 48 cases of overall hypertrophy type, 47 cases of central bulge type, and 2 cases of flat thickening type. Conclusion:The diagnosis of adenoid hypertrophy by virtual endoscopy has high accuracy, which not only avoids the invasive operation of traditional nasopharyngeal endoscopy, but also can observe the adenoid condition and its relationship with the torus tubarius from multiple angles. And, the morphological classification of adenoids using virtual endoscopy has guiding significance for perioperative preparation.

Developments and trends of endoscopic salivary gland resection: from endoscope-assisted to full endoscopic / 华西口腔医学杂志

More than 30 years of rapid development of endoscopic surgery has led to the mainstreaming of this procedure in many surgical departments in China. Since the first report on endoscopy, it has been used in salivary gland resection for more than 20 years. The overall development of endoscopic surgery indicates that its use in oral and maxillofacial surgery is still in the early exploration stage; it has not yet been maturely developed or applied. Owing to the advancement of other disciplines and corresponding widening experiences in those fields, the development of endoscopic technology in oral and maxillofacial surgery will likely achieve a leapfrogging. Learning from the general development pattern of endoscopy, this research explores the application history, current situation, and future direction of the application of endoscopy in salivary gland surgery.

Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery: An Observational Cohort Study in Northeast China / 生物医学与环境科学（英文）

OBJECTIVE@#To explore the association between socioeconomic status (SES) and postoperative outcomes in patients with chronic sinusitis (CRS) after functional endoscopic sinus surgery (ESS).@*METHODS@#We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS. Discharged patients were followed up to 72 weeks for all-cause recurrence events. Baseline SES was established based on occupation, education level, and family income of the patients 1 year before the operation. Kaplan-Meier method was used to calculate the recovery rate after ESS, and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.@*RESULTS@#Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES; 24-week overall recovery rate was 90.4% [95 % confidence interval ( CI): 89.6%-91.2%] in patients of middle SES, 13.5% (95 % CI: 12.8%-14.2%) in patients of low SES, and 31.7% (95 % CI: 30.7%-32.7%) in patients of high SES (both log-rank P < 0.001). After adjustment for covariates, hazard ratios ( HRs) were 7.69 (95 % CI: 6.17-9.71, P trend < 0.001) for all-cause recurrence for low SES versus middle SES, and 6.19 (95 % CI: 4.78-7.93, P trend < 0.001) for middle SES versus high SES.@*CONCLUSION@#Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the Interlaminar Endoscopic Surgical System(iLESSYS) Delta for the treatment of lumbar spinal stenosis (LSS) in the elderly.@*METHODS@#Total of 29 patients with LSS treated with the iLESSYS Delta from December 2018 to January 2021 were retrospectively analyzed, including 12 males and 17 females with an average age of (71.52±10.82) years old ranging from 63 to 83 years old. All patients had definite intermittent claudication, mainly neurogenic symptoms of both lower limbs. All patients had single-level spinal stenosis, including L3,4 5 cases, L4,5 21 cases, and L5S1 3 cases. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified Macnab assessment criteria were used to evaluate pain, low back pain dysfunction index and clinical efficacy, respectively.@*RESULTS@#All 29 cases were successfully completed. The operation time was (73.45±5.89) min, the intraoperative blood loss was (9.93±0.83) ml, the hospital stay was (4.03±0.41) days, and the follow-up was more than 12 months. The VAS scores of low back pain before surgery and 1 day, 1 month, 3 months, 1 year after surgery were 2.31±0.88, 1.45±0.62, 1.21±0.61, 1.10±0.55, 1.03±0.49;VAS of leg pain were 6.48±0.49 0.56, 1.97±0.61, 1.31±0.59, 1.17±0.59, 1.10±0.55;ODI scores were 38.41±2.74, 18.14±1.17, 5.17±0.53, 5.07±0.45, 4.90±0.48;low back and leg pain VAS score and ODI score have statistically significant differences between preoperative and postoperative follow-up time points (P<0.05). The MacNab efficacy evaluation at 1-year follow-up:excellent in 22 cases, good in 5 cases and fair in 2 cases.@*CONCLUSION@#The clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly is satisfactory, with the advantages of less trauma and less bleeding, large microscopic operation space, sufficient decompression, and ideal post-operative recovery, and at the same time, it can minimize the damage to the stable structure of the lumbar spine, which is an ideal surgical method for the treatment of elderly lumbar spinal stenosis.

Gasless submental approach endoscopic removal of thyroglossal cyst / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the safety and feasibility of gasless submental approach endoscopic removal of thyroglossal cyst. Methods: This work prospectively included the clinical data of 13 patients who underwent the gasless submental approach endoscopic removal of thyroglossal cyst at the Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University from August 2021 to February 2022. The operative time, bleeding volumes, postoperative complications, subjective pain levels, satisfaction with incisional scars, neck and facial deformities, and recurrences were prospectively evaluated by visual analogue scale(VAS) score. Results: All of 13 patients were successfully treated using this new technique. The patients had a median age of 38 years, ranging from 24 to 59 years, comprising of 3 males and 10 females. The length of the submental incision was about 3 cm and the median of operation time was 135 minutes. Postoperative complications were minimal. The median volume of blood loss was 10 ml. Surgical site swelling existed in 1 case and dysphagia for more than 1 week occurred in 2 cases. Patients were discharged from the hospital with a median of 3 days after surgery. On a VAS of 0-10 scores, the pain had a median of 2 on the first day after surgery, and the satisfaction with incision scars and neck and facial deformities showed a median of 8 at 6 months after surgery. There were no recurrences during the follow-up period of 9-15 months. Conclusion: Gasless submental approach endoscopic removal of thyroglossal cyst may be a reliable new surgical method that is safe and has cosmetic advantages.

Endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma, based on anatomic studies and surgeries. Methods: Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen. The anatomical landmarks and the extent of exposure were recorded. Six clinical cases who were treated in Eye & ENT Hospital, Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages, including 3 males and 3 females, aged 42 to 69 years old. Descriptive analysis was used in this research. Results: On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle, this approach could fully expose the parapharyngeal, petrosal and paraclival segment internal carotid arteries, and safely deal with the lesions of jugular foramen and petroclival region. The 6 patients in our study tolerated the procedure well. Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction. Conclusion: Endoscopic transoral approach is a safe, minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.

Surgical approach analysis of endoscopic resection of juvenile nasopharyngeal angiofibroma / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the surgical approach for the resection of juvenile nasopharyngeal angiofibroma（JNA） under nasal endoscopy. Methods:The clinical data of 87 patients undergoing endoscopic resection of nasopharyngeal fibroangioma were retrospectively analyzed. We classified JNA according to tumor site, size, invasion scope and anatomic position relationship between tumor and midline of pupil. Three endoscopic surgical approaches were selected according to the classification, and the postoperative symptoms, complications and recurrence were investigated and analyzed. Results:The tumor resection rate of 87 cases by nasal endoscopic surgery was 100%. Thirty-five cases were approached through the middle nasal passage（small tumors located in the nasal sinuses and pterygopalatine fossa）, forty-five cases were approached through the lateral wall of the nasal cavity（tumor invaded the pterygopalatine fossa but did not exceed the midline of the pupil） , and seven cases were approached via the lateral wall of nasal cavity + ipsilateral anterior wall of maxillary sinus（tumor invaded the infratemporal fossa beyond the midline of pupil or invaded the cavernous sinus and the middle cranial fossa epidural）, Postoperative patients with nasal congestion, nasal bleeding, headache, dizziness, vision loss and other symptoms showed varying degrees of improvement. No surgical death or intracranial infection occurred. The postoperative follow-up was 6-78 months, and the recurrence rate was 3.44%. Conclusion:Endoscopic resection of nasopharyngeal fibroangioma is the main treatment method for JNA. Selecting suitable endoscopic approach to resect JNA, To maximize the advantage of nasal endoscopic equipment according to the inherent anatomical space of the human nasal cavity, In order to achieve the purpose of JNA resection, reduce intraoperative and postoperative complications, reduce the recurrence rate and improve the prognosis.

Clinical characteristics of nasal respiratory epithelial adenomatoid hamartoma / 临床耳鼻咽喉头颈外科杂志

〓 Objectives: To analyze the pathological and clinical features of nasal respiratory epithelial adenomatoid hamartoma（REAH）, and summarize the diagnostic points, to improve the experience of diagnosis and treatment. Methods:The clinical data of 16 patients with REAH were analyzed retrospectively. The clinical manifestations, pathological features, imaging features, surgical treatment and prognosis were summarized. Results:16 cases of REAH were studied, 10 cases（62.50%） were associated with sinusitis, 1 case（6.25%） was associated with inverted papilloma, 1 case（6.25%） was associated with hemangioma. 5 cases（31.25%） had a history of nasal sinus surgery, including 1 case with 3 times of nasal sinus surgery, 1 case with 2 times of nasal sinus surgery, 3 cases with 1 time of nasal sinus surgery; 10 cases（62.50%） occurred in the bilateral olfactory cleft, 2 cases（12.50%） in the unilateral olfactory cleft, 3 cases（18.75%） in the unilateral middle turbinate, 1 case（6.25%） in the nasopharynx. All 16 patients were pathologically diagnosed as REAH. In the patients with lesions located in bilateral olfactory fissures, symmetrical widening of olfactory fissures and lateral displacement of middle turbinate were observed on preoperative sinus CT. The average width of bilateral olfactory fissures was （9.9±2.70） mm. The ratio of wide to narrow olfactory cleft was 1.21 ± 0.19. There was no significant difference in Lund-Mackay score between the two sides（P>0.05）. All patients underwent surgery under general anesthesia and nasal endoscopy. The follow-up period ranged from 1 to 66 months, and no recurrence occurred. Conclusion:Preoperative diagnosis of REAH is facilitated by the combination of clinical manifestations and endoscopic and imaging features. Endoscopic complete resection can achieve a good therapeutic effect.

Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach / 中华外科杂志

Objective: To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope. Methods: Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study. There were 7 males and 4 females, aged (47.5±13.5) years (range: 12 to 64 years). The neoplasm involved the pterygopalatine fossa, infratemporal fossa, ethmoidal sinus, sphenoid sinus, cavernous sinus, and middle cranial fossa. The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm. Under general anesthesia, the tumors were resected through the transpterygoid approach in 4 cases, through the prelacrimal recess approach in 4 cases, through the extended prelacrimal recess approach in 2 cases, and through the endoscopic medial maxillectomy approach in 1 case. The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not, and the main clinical symptoms during follow-up. Results: All the surgical procedures were performed under endonasal endoscope, including Gross total resection in 10 patients. The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space. One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve, both of which were removed concurrently. After tumor resection, the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases, including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate, the other case was packed by the autologous fat to protect the dura mater. The operation time was (M(IQR)) 180 (160) minutes (range: 120 to 485 minutes). No complications and deaths were observed. No recurrence was observed in the 10 patients with total tumor resection during a 58 (68) months' (range: 10 to 90 months) follow-up. No obvious change was observed in the facial appearance of all patients during the follow-up. Conclusion: Type D trigeminal schwannoma involving pterygopalatine fossa and infratemporal fossa can be removed safely through purely endoscopic endonasal approach by selecting the appropriate approach according to the size and involvement of the tumor.

Basic principles,methods and evaluation of minimally invasive treatment for infected pancreatic necrosis / 中华外科杂志

Infected pancreatic necrosis(IPN) is the main surgical indication of acute pancreatitis. Minimally invasive debridement has become the mainstream surgical strategy of IPN,and it is only preserved for IPN patients who are not response for adequate non-surgical treatment. Transluminal or retroperitoneal drainage is preferred,and appropriate debridement can be performed. At present,it is reported that video assisted transluminal,trans-abdominal and retroperitoneal approaches can effectively control IPN infection. However,in terms of reducing pancreatic leakage and other complications,surgical and endoscopic transgastric debridement may be the future direction in the treatment of IPN.

Observation of early clinical efficacy of unilateral biportal endoscopy technique in the treatment of lumbar postoperative adjacent segmental diseases / 中国骨伤

OBJECTIVE@#To investigate early clinical efficacy of unilateral biportal endoscopy technique for the treatment of lumbar postoperative adjacent segmental diseases.@*METHODS@#Fourteen patients with lumbar postoperative adjacent segmental diseases were treated with unilateral biportal endoscopy technique from June 2019 to June 2020. Among them, there were 9 males and 5 females, aged from 52 to 73 years old, and the interval between primary and revision operations ranged from 19 to 64 months. Adjacent segmental degeneration occurred after lumbar fusion in 10 patients and after lumbar nonfusion fixation in 4 patients. All the patients received unilateral biportal endoscopy assisted posterior unilateral lamina decompression or unilateral approach to the contralateral decompression. The operation time, postoperative hospital stay and complications were observed. The visual analogue scale (VAS) of low back pain and leg pain, Oswestry Disability Index (ODI), modified Japanese Orthopaedic Association (mJOA) score were recorded before operation and at 3 days, 3 months, and 6 months after operation.@*RESULTS@#All procedures were successfully completed. Surgical duration ranged from 32 to 151 min. Postoperative CT showed adequate decompression and preservation of most joints. Out of bed walking 1 to 3 days after surgery, postoperative hospital stay was 1 to 8 days, and postoperative follow-up was 6 to 11 months. All 14 patients returned to normal life within 3 weeks after surgery, and VAS, ODI, and mJOA scores improved significantly at 3 days and 3, 6 months after surgery. One patient occurred cerebrospinal fluid leak after operation, received local compression suture, and the wound healed after conservative treatment. One patient occurred postoperative cauda equina neurologic deficit, which was gradually recovered about 1 month after rehabilitation therapy. One patients advented transient pain of lower limbs after surgery, and the symptoms were relieved after 7 days of treatment with hormones, dehydration drugs and symptomatic management.@*CONCLUSION@#Unilateral biportal endoscopy technique has a good early clinical efficacy in the treatment of lumbar postoperative adjacent segmental diseases, which may provide a new minimally invasive, non-fixation option for the treatment of adjacent segment disease.

Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis / 中国修复重建外科杂志

OBJECTIVE@#To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS).@*METHODS@#The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized.@*RESULTS@#At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs.@*CONCLUSION@#The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.

Percutaneous foraminal endoscopy for the treatment of lumbar lateral recess stenosis in elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.